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Hepatorenal syndrome - recommended treatments

MEDICINES INFORMATIONFREQUENTLY ASKED QUESTION

Question:

What are the recommended treatments for hepatorenal syndrome?

Background:

Hepatorenal syndrome (HRS) is the development of renal failure in patients with advanced chronic liver disease, occasionally fulminant hepatitis, who have portal hypertension and ascites. It is very difficult to treat and mortality is high. Oral pentoxifylline is often used (a small study in 101 patients with severe disease showed that fewer patients died while in hospital than those taking placebo) but there is no information on longer term survival.

There is limited evidence that both terlipressin and acetylcysteine may improve renal function and both are used in the Liver Unit at Kings.

Answer:

Pentoxfylline is often used first line. The oral dose = 400mg, three times daily (1)

Terlipressin = 1mg IV twice or three times daily. The length of treatment varies but in trials it has been used for up to 15 days. It may be given together with albumin. (2)

Acetylcysteine dose = 150mg/kg in 250ml 5% glucose given as a continuous IV infusion over 24 hours. This can be continued for as long as necessary. (3)

On this website you will now see four icons for these resources rather than two. Please use BNF Legacy or BNF for Children Legacy as these will take you to the original format of the online publications which do not have any errors or omissions.